Provider Demographics
NPI:1740652403
Name:REMCHUK, CONNIE ANN (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:ANN
Last Name:REMCHUK
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 455
Mailing Address - Street 2:1585 MILITARY TURNPIKE
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-0455
Mailing Address - Country:US
Mailing Address - Phone:518-561-0100
Mailing Address - Fax:518-561-5624
Practice Address - Street 1:1585 MILITARY TURNPIKE
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-0455
Practice Address - Country:US
Practice Address - Phone:518-561-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382085163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse